川崎病患儿中-大型冠状动脉瘤回缩预后及影响因素  

Prognosis and influencing factors of retraction of medium-large coronary artery aneurysm in children with Kawasaki disease

作　　者：王波[1] 朱琨 阚惠娟 张斌 束文娟 侯淼[1] WANG Bo;ZHU Kun;KAN Hui-juan;ZHANG Bin;SHU Wen-juan;HOU Miao(Department of Cardiology,Children s Hospital of Soochow University,Suzhou,Jiangsu 215000,China;不详)

机构地区：[1]苏州大学附属儿童医院心内科,江苏苏州215000 [2]盐城市第一人民医院儿童医学中心儿内科,江苏盐城224006 [3]苏州市立医院东区儿内科,江苏苏州215001

出　　处：《中国临床研究》2022年第10期1333-1338,共6页Chinese Journal of Clinical Research

基　　金：国家自然科学基金青年项目(82000467)。

摘　　要：目的 探讨川崎病患儿中-大型冠状动脉瘤(CAA)的回缩预后及影响其回缩的因素。方法 回顾性分析2018年1月1日至2021年8月31日在苏州大学附属儿童医院确诊为川崎病合并中-大型CAA 43例患儿的临床资料,其中男33例,女10例。根据随访6个月后是否仍残留中-大型CAA,分为CAA回缩组(22例)及未回缩组(21例)。收集所有对象入院时的血常规、血生化检测、急性期和随访6个月后的心脏彩超结果并进行分析。结果 43例患儿中急性期合计累及冠状动脉(冠脉)血管89支:左主干13支,左前降支24支,左回旋支5支,右冠近段6支,右冠中段20支,右冠远段21支。随访半年后,所有冠脉分支内径均有缩小趋势,其中61支受累冠脉已无中-大型CAA残留;仍残余中-大型CAA的冠脉共28支:左主干3支,左前降支8支,右冠中段8支,右冠远段9支。随访结束时,回缩组中2例患儿冠脉已经完全恢复正常,余20例受累冠脉已无中-大型CAA残留。回缩组患儿急性期血红蛋白、丙氨酸氨基转移酶/天冬氨酸氨基转移酶(ALT/AST)比值低于未回缩组,而血小板计数高于未回缩组(P<0.05)。Logistic回归分析发现,急性期扩张冠脉最大内径Z值和ALT/AST比值增高均是影响冠脉恢复的危险因素(P<0.01)。扩张冠脉最大内径Z值和ALT/AST比值诊断冠脉回缩的截断值分别为10.84、1.16,ROC曲线下面积分别为0.721、0.775。结论 川崎病中-大型CAA以左冠脉前降支、右冠脉中远段多见,随访6个月后左前降支及右冠中远段仍有约1/3受累血管有中型以上CAA持续存在;急性期冠脉扩张严重程度和ALT/AST比值高是影响川崎病患儿CAA恢复的危险因素。Objective To investigate the factors affecting the retraction of medium-large coronary artery aneurysm(CAA) in children with Kawasaki disease(KD).Methods A retrospective analysis was performed on the clinical data of 43 KD children complicated with medium-large CAA diagnosed in Children’s Hospital of Soochow University from January 1,2018 to August 31,2021,including 33 males and 10 females.According to the retraction of coronary aneurysm after 6 months of follow-up,the patients were divided into CAA retraction group(n=22) and CAA non-retraction group(n=21).The results of blood routine examination,blood biochemical measurements at admission and cardiac color Doppler ultrasound during acute stage and after 6-month follow-up were collected and statistically analyzed.Results Among the 43 children,a total of 89 coronary vessels were involved,including 13 left main coronary artery(LMCA),24 left anterior descending artery(LAD),5 left circumflex artery(LCX),6 proximal right coronary artery(RCA),20 middle RCA,and 21 distal RCA.After six months of follow-up,the diameter of all involved coronary branches had a tendency to decrease,of which 61 involved coronary arteries had no residual medium-large CAA.The remaining 28 coronary arteries were still with residual CAA,including 3 LMCA,8 LAD,8 middle RCA and 9 distal RCA.At the end of follow-up,the coronary arteries of 2 children in retraction group had completely recovered to normal,and the remaining 20 affected coronary arteries had no medium-large CAA residue.The level of hemoglobin and the ratio of alanine aminotransferase/aspartate aminotransferase(ALT/AST) in retraction group were significantly lower than those in non-retraction group,while the platelet count was higher than that in non-retraction group(P<0.05).Regression analysis showed that the maximum inner diameter Z value of dilated coronary artery lesion(CAL Zmax) and ALT/AST ratio increasing in the acute phase were the risk factors influencing recovery of coronary artery(P<0.01).The cut-off value of CAL Zmax for p

关 键 词：川崎病 冠状动脉瘤 回缩 丙氨酸氨基转移酶/天冬氨酸氨基转移酶 冠状动脉扩张最大内径 

分 类 号：R543.32[医药卫生—心血管疾病]